Rare Leadership | Considering Problems as Gifts

I have the honor to work with senior executives from a variety of industries. One of the most difficult jobs, in my humble opinion, is that of the healthcare system CEO. The healthcare landscape has been changing for two decades and is rapidly changing. The CEO who remains “hospital-centric” in his views is likely to be overcome by change. Wise is the healthcare CEO who not only sees the overlaps between ambulatory, acute and “home”/wellness care, but also acts on what he sees.

Because of my unique relationship with these senior leaders, I get to see them at their worst and their best. The context (usually) is in our work as Operational Excellence strategists, architects, and coaches. Today I witnessed one of those “best” moments as I read through a communication from a CEO to his leadership team concerning how they were to respond to problems from outside of their organization, in this case, one of their local home healthcare providers.

Kim Hollon has been the CEO of Signature Healthcare in Brockton, MA, nigh on six years. Kim is a soft-spoken, thoughtful man, noted for his Alabama accent and his quirky “country” sayings (things about pigs and cows applied metaphorically to every kind of business situation). He is also noted for his fierce adherence to his vision that too many patients are harmed in a system purporting not to harm them. My team has been supporting his team – nix that – my team and his team have been strategic partners for five of those six. Kim will be sharing his story of transformation based on what they call “lean” at this year’s AME International Conference in Dallas, TX. Lean can be a narrow term, but for Kim and his team, lean has always been about solving problems. In the true spirit of operational excellence, his team has been pursuing continuous improvement for some time and has seen excellent operational results.

For me, though, as a student of leadership, Signature’s biggest advances have been in their human development results, particularly the courageous leadership displayed from the front line, right up to the CEO’s office. I think we’d all agree that leadership throughout an organization is due in large part to the daily experiences cultivated by senior leaders. Signature is no exception to the rule. Signature is exceptional when it comes to the courage to navigate to what we call the “plumb line” of value-centric leadership: pricking the heart values of the team and expecting a forceful response.

Today, I read a short communication that Kim sent directly to his some 150 leaders. I read it twice because Kim said, “…you will likely be presented with ‘gifts’ (from organizations outside ours) in the form of problems.” Now, if you are reading this flatly and if you didn’t know Kim, you might think that his statement was artful sarcasm. Which one of us hasn’t quipped about problems that are thrown at us “over the transom”?

He wasn’t being sarcastic.

This was one of his best leadership moments and one that – as humble as he is – I asked permission to share with you. This isn’t about pitting one CEO’s behavior against another. It is about the rare leadership ability to communicate doing what is right instead of what is easy. The subject of his communication was, “The Problems We Hear from our Partners are Special Gifts.” Here is most of the communication (emphasis in bold is mine):

Our patients need your help. We have an obligation to improve the quality of care and service across the continuum, yet we are just one part of a disconnected system where they receive health services. Given the incentives of the emerging risk based/global payment model of care, we must create value for our patients by improving coordination and handoffs across the system of care they experience. A key element of this strategy is to work with our external partners to see potential problems from their unique perspective. For example, we only see a patient’s discharge from the hospital’s perspective, but a home health nurse sees how well a patient is able to remember and effectively use our discharge education while in the home.

As we work with our partners to see problems in a new way, you will likely be presented with ‘gifts’ from our partners in the form of problems. All kidding aside, these really are gifts because they are problems from a viewpoint difficult for us to routinely see. And these problems, when solved, will help improve care for our patients across the continuum of care.

We take this initiative seriously. We placed a (Signature-funded) Lean specialist … inside of (a strategic local home health service provider) with two main goals: 1. Enhance the (partner’s) Lean platform, allowing us to collaboratively work to improve care across the patient’s continuum; and, 2. Develop a standard care transition pathway to increase the quality and timeliness of care and improve patient outcomes. This project is expected to take two years to complete. At some point in the future, I hope we can extend our Lean resources to other providers across the spectrum.

If you are presented with a problem from the (partner), please be empathetic with the staff from their agency. We partnered with them and are teaching them to use our problem solving system to improve care for our patients. Ultimately they are dependent on us for much of their volume, and in the past may not have told us where we could improve, for fear of sending a message they were not appreciative of our referral. Building a strong quality improvement culture between our organizations takes support of their movement into Lean by partnering with them on problem solving.

…problems are gifts. Sound crazy?

The crazy thing is that this CEO believes it. This CEO demonstrates rare leadership by being courageous enough not just to get his own house in order, but, when that is stable, to also “reach out” to help others. He realizes that as he helps the organizations that Signature is connected with to get better, Signature gets better.

Little moments like this are few and far between when you are in the continuous improvement business; looking for problems and exceptions is our norm. Every once in awhile, we get to share in a moment where fear gets crushed by courage, leaders lead and the customer – in this case, some of the most complex patients being served – benefits from it.

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Dave, thank you for sharing this inspirational story. Having had the opportunity to learn about Kim and his work had been a source of motivation for me in my own work. Leadership and lean amplify each other.